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Online Services New!
Download these forms onto your computer to print and complete at home. You may bring in the completed forms or Fax them to our office:
(212)585-3717

We now offer the following forms online to better serve you:
Swine Flu Vaccination Guidelines

Patient Information: If your child is a new Patient to Global Pediatrics, completing this form ahead of time will save you time in our waiting room!

Credit Card Authorization: For all payments to Global Pediatrics by Credit Card, you will need to complete this form.

Financial Policy: A form you must sign to acknowledge our Financial Policy.

Record Transfer Request: Complete this form to consent to release of your child's records.

Health Insurance Portability and Accountability Act of 1996 - Notice of Privacy Practices Brochure.

Consent for Treatment without Parent Consent: Complete this form to give consent for your child to be treated in your absence.

Flu Vaccination Consent & Release

Flu Waiver


Treating the children of the Upper East Side since 1980.

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